The Optimal Timing of Endovascular Thrombectomy For Ischemic Stroke: A Meta-analysis

Saver et al. analyzed pooled data of 1,287 patients from five large randomized phase 3 trials evaluating the use of mechanical thrombectomy vs medical management in the emergent treatment of acute ischemic stroke secondary to large vessel occlusion (MR CLEAN, ESCAPE, EXTEND-IA, REVASCAT, SWIFT PRIME) to assess the relationship between “time to treat” and patient outcomes. Efficacy outcomes were 3-month modified Rankin Score (mRS), “functional independence” (mRS = 0-2), and “excellent outcome” (mRS 0-1). Outcomes were compared in patients treated medically only, with thrombectomy, and with thrombectomy with good perfusion (TICI 2b or 3). The data showed clear benefit with less disability in patients receiving thrombectomy with reperfusion compared to medical management, with an odds ratio of 2.79 (95% CI, 1.96-3.98) if treated within 3 hours of symptom onset. Each hour of treatment delay led to a decline in the benefit for thrombectomy patients until 7 hours and 18 minutes, at which point the relative benefit of thrombectomy no longer met statistical significance.